title: Analysis of swallowing after partial frontolateral laryngectomy with epiglottic reconstruction for glottic cancer.
abstract: The aim of the study was to evaluate swallowing using a reproducible objective methodology and to seek preoperative factors that could influence swallowing outcomes in patients operated on for partial laryngectomy. Twenty-four patients who underwent partial frontolateral laryngectomy with epiglottic reconstruction for T1bN0 or T2N0 glottic carcinoma between 2008 and 2012 were retrospectively evaluated. Using fiberoptic endoscopic and videofluoroscopic evaluation, early (15 days postoperatively) and late (2 months postoperatively) scores were obtained for all patients to quantify their swallowing skills. Eighty-three percent of patients achieved at least partial oral feeding at time of hospital discharge and 87.5% achieved exclusive oral feeding within 2 months postoperatively. Early score was good or excellent in 50%, average in 4.2% and poor in 41.8%. Regarding late scores, 63% were classified as having a good or excellent late score, 7 patients (29%) were classified as "middle result" because their time to recover was longer (i.e. between 1 and 2 months postoperatively), and two patients had a poor late score. Finally, at last follow-up, only one patient was partially fed by gastrostomy (180 days after surgery). T stage (p = 0.04) was the only factor influencing early swallowing outcomes and length of hospital stay was longer for poor scores than for good late results (p = 0.02). Our findings show good outcomes in terms of postoperative swallowing. Objective assessment of deglutition is essential for a better understanding of the mechanisms of postoperative swallowing disorders and for patient selection.
authors.affiliation: Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, 264 rue Saint Pierre, 13385, Marseille Cedex 05, France, nicolas.fakhry@ap-hm.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Fakhry
authors.forename: Justin
authors.initials: J
authors.lastname: Michel
authors.forename: Roch
authors.initials: R
authors.lastname: Giorgi
authors.forename: Danielle
authors.initials: D
authors.lastname: Robert
authors.forename: Aude
authors.initials: A
authors.lastname: Lagier
authors.forename: Laure
authors.initials: L
authors.lastname: Santini
authors.forename: Eric
authors.initials: E
authors.lastname: Moreddu
authors.forename: Laurent
authors.initials: L
authors.lastname: Puymerail
authors.forename: Pascal
authors.initials: P
authors.lastname: Adalian
authors.forename: Patrick
authors.initials: P
authors.lastname: Dessi
authors.forename: Antoine
authors.initials: A
authors.lastname: Giovanni
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000503:physiopathology / Q000601:surgery*; D003679:Deglutition / Q000502:physiology*; D004825:Epiglottis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis; D006801:Humans; D007822:Laryngeal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D007825:Laryngectomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome